Risk Factors for Fecal Incontinence After Intersphincteric Resection for Rectal Cancer
BACKGROUND:Restoration of bowel continuity is a major goal after surgical treatment of rectal cancer. Intersphincteric resection allows sphincter preservation in low rectal cancer but may have poor functional results, including frequent bowel movements, urgency, and incontinence. OBJECTIVE:This stud...
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| Veröffentlicht in: | Diseases of the colon & rectum 2011-08, Vol.54 (8), p.963-968 |
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| creator | Denost, Quentin Laurent, Christophe Capdepont, Maylis Zerbib, Frank Rullier, Eric |
| description | BACKGROUND:Restoration of bowel continuity is a major goal after surgical treatment of rectal cancer. Intersphincteric resection allows sphincter preservation in low rectal cancer but may have poor functional results, including frequent bowel movements, urgency, and incontinence.
OBJECTIVE:This study aimed to evaluate long-term functional outcome after intersphincteric resection to identify factors predictive of good continence.
DESIGN:Descriptive observational study.
SETTING:Follow-up of surgery in tertiary care university hospital.
PATIENTS:Eligible patients were without recurrence 1 year or more after surgery for low rectal cancer.
INTERVENTION:Intersphincteric resection.
MAIN OUTCOME MEASURES:Bowel function was assessed with a standardized questionnaire sent to patients. Functional outcome was considered as good if the Wexner score was 10 or less. Univariable and multivariable regression analyses were used to evaluate impact of age, gender, body mass index, tumor stage, tumor location, distance of the tumor from the anal verge and from the anal ring, type of surgery, colonic pouch, height of the anastomosis, pelvic sepsis, and preoperative radiotherapy on functional outcome.
RESULTS:Of 125 eligible patients, 101 responded to the questionnaire. Median follow-up was 51 (range, 13–167) months. In multivariate analyses, the only independent predictors of good continence were distance of the tumor greater than 1 cm from the anal ring (OR, 5.88; 95% CI, 1.75–19.80; P = .004) and anastomoses higher than 2 cm above the anal verge (OR, 6.59; 95% CI, 1.12–38.67; P = .037).
LIMITATIONS:The study is limited by its retrospective, observational design and potential bias due to possible differences between those who responded to the questionnaire and those who did not.
CONCLUSIONS:Patient characteristics do not appear to influence functional outcome at long-term follow-up after intersphincteric resection. The risk of fecal incontinence depends mainly on tumor level and height of the anastomosis. |
| doi_str_mv | 10.1097/DCR.0b013e31821d3677 |
| format | Article |
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OBJECTIVE:This study aimed to evaluate long-term functional outcome after intersphincteric resection to identify factors predictive of good continence.
DESIGN:Descriptive observational study.
SETTING:Follow-up of surgery in tertiary care university hospital.
PATIENTS:Eligible patients were without recurrence 1 year or more after surgery for low rectal cancer.
INTERVENTION:Intersphincteric resection.
MAIN OUTCOME MEASURES:Bowel function was assessed with a standardized questionnaire sent to patients. Functional outcome was considered as good if the Wexner score was 10 or less. Univariable and multivariable regression analyses were used to evaluate impact of age, gender, body mass index, tumor stage, tumor location, distance of the tumor from the anal verge and from the anal ring, type of surgery, colonic pouch, height of the anastomosis, pelvic sepsis, and preoperative radiotherapy on functional outcome.
RESULTS:Of 125 eligible patients, 101 responded to the questionnaire. Median follow-up was 51 (range, 13–167) months. In multivariate analyses, the only independent predictors of good continence were distance of the tumor greater than 1 cm from the anal ring (OR, 5.88; 95% CI, 1.75–19.80; P = .004) and anastomoses higher than 2 cm above the anal verge (OR, 6.59; 95% CI, 1.12–38.67; P = .037).
LIMITATIONS:The study is limited by its retrospective, observational design and potential bias due to possible differences between those who responded to the questionnaire and those who did not.
CONCLUSIONS:Patient characteristics do not appear to influence functional outcome at long-term follow-up after intersphincteric resection. The risk of fecal incontinence depends mainly on tumor level and height of the anastomosis.</description><identifier>ISSN: 0012-3706</identifier><identifier>EISSN: 1530-0358</identifier><identifier>DOI: 10.1097/DCR.0b013e31821d3677</identifier><identifier>PMID: 21730784</identifier><identifier>CODEN: DICRAG</identifier><language>eng</language><publisher>Hagerstown, MDc: The ASCRS</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anal Canal - physiopathology ; Anal Canal - surgery ; Biological and medical sciences ; Digestive System Surgical Procedures - adverse effects ; Fecal Incontinence - etiology ; Female ; Follow-Up Studies ; Gastroenterology. Liver. Pancreas. Abdomen ; Humans ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Rectal Neoplasms - surgery ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus ; Surveys and Questionnaires ; Tumors ; Young Adult</subject><ispartof>Diseases of the colon & rectum, 2011-08, Vol.54 (8), p.963-968</ispartof><rights>The ASCRS 2011</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4479-15a03132924b083112eeb0318144488231c69e9a7be267d9621ccad42e7b23663</citedby><cites>FETCH-LOGICAL-c4479-15a03132924b083112eeb0318144488231c69e9a7be267d9621ccad42e7b23663</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,778,782,27911,27912</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24388355$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21730784$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Denost, Quentin</creatorcontrib><creatorcontrib>Laurent, Christophe</creatorcontrib><creatorcontrib>Capdepont, Maylis</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Rullier, Eric</creatorcontrib><title>Risk Factors for Fecal Incontinence After Intersphincteric Resection for Rectal Cancer</title><title>Diseases of the colon & rectum</title><addtitle>Dis Colon Rectum</addtitle><description>BACKGROUND:Restoration of bowel continuity is a major goal after surgical treatment of rectal cancer. Intersphincteric resection allows sphincter preservation in low rectal cancer but may have poor functional results, including frequent bowel movements, urgency, and incontinence.
OBJECTIVE:This study aimed to evaluate long-term functional outcome after intersphincteric resection to identify factors predictive of good continence.
DESIGN:Descriptive observational study.
SETTING:Follow-up of surgery in tertiary care university hospital.
PATIENTS:Eligible patients were without recurrence 1 year or more after surgery for low rectal cancer.
INTERVENTION:Intersphincteric resection.
MAIN OUTCOME MEASURES:Bowel function was assessed with a standardized questionnaire sent to patients. Functional outcome was considered as good if the Wexner score was 10 or less. Univariable and multivariable regression analyses were used to evaluate impact of age, gender, body mass index, tumor stage, tumor location, distance of the tumor from the anal verge and from the anal ring, type of surgery, colonic pouch, height of the anastomosis, pelvic sepsis, and preoperative radiotherapy on functional outcome.
RESULTS:Of 125 eligible patients, 101 responded to the questionnaire. Median follow-up was 51 (range, 13–167) months. In multivariate analyses, the only independent predictors of good continence were distance of the tumor greater than 1 cm from the anal ring (OR, 5.88; 95% CI, 1.75–19.80; P = .004) and anastomoses higher than 2 cm above the anal verge (OR, 6.59; 95% CI, 1.12–38.67; P = .037).
LIMITATIONS:The study is limited by its retrospective, observational design and potential bias due to possible differences between those who responded to the questionnaire and those who did not.
CONCLUSIONS:Patient characteristics do not appear to influence functional outcome at long-term follow-up after intersphincteric resection. The risk of fecal incontinence depends mainly on tumor level and height of the anastomosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anal Canal - physiopathology</subject><subject>Anal Canal - surgery</subject><subject>Biological and medical sciences</subject><subject>Digestive System Surgical Procedures - adverse effects</subject><subject>Fecal Incontinence - etiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Rectal Neoplasms - surgery</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</subject><subject>Surveys and Questionnaires</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0012-3706</issn><issn>1530-0358</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNFr2zAQxkVZabO2_8EYfhl9cnunky35MWTLFggMQttXIStn4sWxM8mh7L-f0qYrTA_S3cf33aGfEJ8Q7hAqff91trqDGpCY0EhcU6n1mZhgQZADFeaDmACgzElDeSk-xvgrtSBBX4hLiZpAGzURT6s2brO58-MQYtYMIZuzd1226P3Qj23Pveds2owckpTuuN-0vU9F67MVR_ZjO_QvuVWqU3DmUiJci_PGdZFvTu-VeJx_e5j9yJc_vy9m02XuldJVjoUDQpKVVDUYQpTMdVIMKqWMkYS-rLhyumZZ6nVVSvTerZVkXUsqS7oSt69z92H4feA42l0bPXed63k4RGt0oSpUmpJTvTp9GGIM3Nh9aHcu_LEI9gjUJqD2f6Ap9vm04FDveP0v9EYwGb6cDC4mcE1I_2_ju0-RMVQU7_ufh-7IcdsdnjnYDbtu3FhIh1RBuQREMKnLj1JFfwGwWYyJ</recordid><startdate>201108</startdate><enddate>201108</enddate><creator>Denost, Quentin</creator><creator>Laurent, Christophe</creator><creator>Capdepont, Maylis</creator><creator>Zerbib, Frank</creator><creator>Rullier, Eric</creator><general>The ASCRS</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201108</creationdate><title>Risk Factors for Fecal Incontinence After Intersphincteric Resection for Rectal Cancer</title><author>Denost, Quentin ; Laurent, Christophe ; Capdepont, Maylis ; Zerbib, Frank ; Rullier, Eric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4479-15a03132924b083112eeb0318144488231c69e9a7be267d9621ccad42e7b23663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anal Canal - physiopathology</topic><topic>Anal Canal - surgery</topic><topic>Biological and medical sciences</topic><topic>Digestive System Surgical Procedures - adverse effects</topic><topic>Fecal Incontinence - etiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Stomach. Duodenum. Small intestine. Colon. Rectum. Anus</topic><topic>Surveys and Questionnaires</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Denost, Quentin</creatorcontrib><creatorcontrib>Laurent, Christophe</creatorcontrib><creatorcontrib>Capdepont, Maylis</creatorcontrib><creatorcontrib>Zerbib, Frank</creatorcontrib><creatorcontrib>Rullier, Eric</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Diseases of the colon & rectum</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Denost, Quentin</au><au>Laurent, Christophe</au><au>Capdepont, Maylis</au><au>Zerbib, Frank</au><au>Rullier, Eric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk Factors for Fecal Incontinence After Intersphincteric Resection for Rectal Cancer</atitle><jtitle>Diseases of the colon & rectum</jtitle><addtitle>Dis Colon Rectum</addtitle><date>2011-08</date><risdate>2011</risdate><volume>54</volume><issue>8</issue><spage>963</spage><epage>968</epage><pages>963-968</pages><issn>0012-3706</issn><eissn>1530-0358</eissn><coden>DICRAG</coden><abstract>BACKGROUND:Restoration of bowel continuity is a major goal after surgical treatment of rectal cancer. Intersphincteric resection allows sphincter preservation in low rectal cancer but may have poor functional results, including frequent bowel movements, urgency, and incontinence.
OBJECTIVE:This study aimed to evaluate long-term functional outcome after intersphincteric resection to identify factors predictive of good continence.
DESIGN:Descriptive observational study.
SETTING:Follow-up of surgery in tertiary care university hospital.
PATIENTS:Eligible patients were without recurrence 1 year or more after surgery for low rectal cancer.
INTERVENTION:Intersphincteric resection.
MAIN OUTCOME MEASURES:Bowel function was assessed with a standardized questionnaire sent to patients. Functional outcome was considered as good if the Wexner score was 10 or less. Univariable and multivariable regression analyses were used to evaluate impact of age, gender, body mass index, tumor stage, tumor location, distance of the tumor from the anal verge and from the anal ring, type of surgery, colonic pouch, height of the anastomosis, pelvic sepsis, and preoperative radiotherapy on functional outcome.
RESULTS:Of 125 eligible patients, 101 responded to the questionnaire. Median follow-up was 51 (range, 13–167) months. In multivariate analyses, the only independent predictors of good continence were distance of the tumor greater than 1 cm from the anal ring (OR, 5.88; 95% CI, 1.75–19.80; P = .004) and anastomoses higher than 2 cm above the anal verge (OR, 6.59; 95% CI, 1.12–38.67; P = .037).
LIMITATIONS:The study is limited by its retrospective, observational design and potential bias due to possible differences between those who responded to the questionnaire and those who did not.
CONCLUSIONS:Patient characteristics do not appear to influence functional outcome at long-term follow-up after intersphincteric resection. The risk of fecal incontinence depends mainly on tumor level and height of the anastomosis.</abstract><cop>Hagerstown, MDc</cop><pub>The ASCRS</pub><pmid>21730784</pmid><doi>10.1097/DCR.0b013e31821d3677</doi><tpages>6</tpages></addata></record> |
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| ispartof | Diseases of the colon & rectum, 2011-08, Vol.54 (8), p.963-968 |
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| subjects | Adult Aged Aged, 80 and over Anal Canal - physiopathology Anal Canal - surgery Biological and medical sciences Digestive System Surgical Procedures - adverse effects Fecal Incontinence - etiology Female Follow-Up Studies Gastroenterology. Liver. Pancreas. Abdomen Humans Male Medical sciences Middle Aged Other diseases. Semiology Rectal Neoplasms - surgery Retrospective Studies Risk Factors Severity of Illness Index Stomach. Duodenum. Small intestine. Colon. Rectum. Anus Surveys and Questionnaires Tumors Young Adult |
| title | Risk Factors for Fecal Incontinence After Intersphincteric Resection for Rectal Cancer |
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